For information regarding finishing a case, refer to the following:

• Overview
• Residual Spaces
• Incomplete Rotations
• Teeth are not aligning as expected
• Irregular or uneven incisal edges and marginal ridges
• Occlusion not fully interdigitated or idealized
• Posterior openbite due to intruded posterior teeth
• Posterior openbite due to spontaneous mandibular advancement
• Black triangles

Overview

Doctors often request a revision for some final touch-ups to home in on the treatment goals. For instance, you might want to request some additional aligners to close a gap or complete a rotation while the patient wears the final planned aligners.

Revisions can be requested to help complete treatment, even if you have already used the allotted number of revisions associated with the treatment option you originally selected. The option to add additional revisions to extend treatment is available for any case, after the terms have expired at FLEX prices. This allows you to make any finishing touch-ups that you and your patient require to achieve the treatment goals for the case.

Determining if treatment is finished to your standards and your patient’s satisfaction once the last aligner has been worn gives you both the opportunity to take advantage of all options for correcting any undesirable issues.

Sometimes, your perception of a nicely finished case is different from the patient’s. When you give the patient an opportunity to express their satisfaction with the treatment result before announcing that treatment is finished, your patient will feel like you care about how they feel about their result.

Identifying potential issues prior to the last aligner

The following are some potential issues and the steps you can take.

Residual Spaces

Unintended or residual spacing can occur for a few different reasons.

• Patient is non-compliant with aligner wear instructions
• Too much IPR was done and not properly or adequately closed with treatment
• Patient's anatomy and bone biology

What to do

• Review the treatment setup to confirm that there should be no spaces remaining
• Order a case revision to close the spaces
• Request a ‘digital power chain’ in a case revision to ensure the remaining spaces are closed (ClearCorrect can adjust the 3D model to lingualize all the spaced teeth by about 0.2 mm, pulling the teeth closer together the same way a power chain does)

Incomplete rotations

Patients are most aware of “imperfections” with the upper and lower incisors.

What to do

• Continue with the last aligner for an additional couple of weeks – you may want to consider using the ‘dimples’ technique to complete the rotation 
• You can fabricate an in-office reset aligner to complete the rotation or request a replacement of this last step 
• Order a revision to complete the rotation

Remember – there must be adequate space to rotate the tooth into (see image below)

Teeth are not aligning as expected

In the example below, there’s not enough space to align the upper left central incisor.

A situation like the above requires a revision to provide more expansion or proclination to open sufficient space to optimize the alignment of those incisors; there is too much crowding for IPR.

What to do

• Order a case revision to get the remaining alignment needed

Irregular or uneven incisal edges and marginal ridges

What to do

• In many cases of mild incisor edge irregularities, conservative enamoplasty to smooth the incisal edges slightly will significantly improve the appearance of the whole smile line and impress the patient with how much better their teeth look.
• In situations of moderate to severe incisal edge or occlusal wear, restorative dentistry could be of great benefit to provide a better esthetic result

Occlusion not fully interdigitated or idealized

The example below shows an idealized, fully interdigitated Class I occlusion that may or may not have been the original goal, but it serves as an example of an optimal result. The doctor can use this example to compare his result, based upon his original goals. Not all finished results must look like this ideal. The dental circumstances and preferences presented by the patient may prevent the dentist from accomplishing a finish like this.

What to do

• Order a case revision to achieve the full interdigitation desired

Posterior openbite due to intruded posterior teeth

This is thought to be caused by extreme masseter activity when wearing aligners and is the most commonly proposed etiology, which is an intuitive explanation, but not proven by clinical research.

What to do

• Remove the posterior section of the aligner to allow settling of the intruded teeth

Posterior openbite due to spontaneous mandibular advancement

• Over-lapping incisors (deepbite) cause the condyle to be displaced distally in the fossa
• As the aligners correct the deepbite, the jaw will not be forced back into a distal displacement in the fossa; relieved of that distal pressure on the mandible, the muscles will be able to ‘relax’, allowing the mandible to slowly come forward to where the muscles want to be and are more comfortable.
• Distally displaced condyles (and chin) relax forward
• Advancing mandible may cause new premature incisor contact which prevents closure of the posterior teeth

What to do

• In order to allow the posterior teeth to contact, the incisors need more torque and/or intrusion, request a revision to achieve the needed movement
• Remove the posterior section of the aligner to allow settling of the intruded teeth
• The posterior openbite may be closed using limited brackets and vertical elastics

Black triangles

Black triangles can happen with any method of alignment, including traditional braces. This is a natural consequence of alignment correction, so it can't always be avoided.

What to do

• Alert the patient pre-treatment of the potential if it exists
• Re-contour (IPR) wide incisal edges
• Emphasize with patient the importance of an optimum oral hygiene regimen

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